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Servicios de autorización

Injury Care Associates facilita la recepción de servicios. Aceptamos visitas sin necesidad de cita y visitas con citas programadas.

Llene la Autorización del empleador a continuación para especificar los servicios que desea que Injury Care Associates realice.

Injury Care Associates acepta autorizaciones a través del envío electrónico a continuación, por teléfono o puede descargar una copia de nuestro Formulario de autorización del empleador y enviarlo por fax a la clínica o hacer que su empleado lo lleve a la clínica. Si su empleado llega a la clínica sin una Autorización del empleador, nos comunicaremos con usted para verificar los servicios que necesita para garantizar una prestación de servicios completa y precisa.

PDF Form
Employee Information

Employee Information


Work Related Injury, Illness or Exposure


Drug & Alcohol Testing


Physical Examination
Physical Examination

OSHA Exam

OSHA Examination


Immunizations

Blood testing

Blood Titer Testing


Additional Services

Please any and all additional sevices you would like Injury Care Associates

Other

Authorizer's Information

Please provide the information requested below in case Injury Care Associates needs to contact you with any questions.


Please note that only patient and staff are allowed in the drug/alcohol testing and clinical areas and that employer, family and friends will be asked to remain in the waiting area. Please notify your employee so they may plan accordingly